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Am J Obstet Gynecol. 2017 Nov;217(5):610.e1-610.e8. doi: 10.1016/j.ajog.2017.06.008. Epub 2017 Jun 12.

Single-port laparoscopy in gynecologic oncology: seven years of experience at a single institution.

Author information

1
Division of Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH. Electronic address: moultol@ccf.org.
2
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Louisiana State University Healthcare Network, New Orleans, LA.
3
Division of Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH.
4
Case Western Reserve School of Medicine, Cleveland, OH.
5
Instituto Gyneco-Oncólogico, San Juan, Puerto Rico.
6
Division of Gynecologic Oncology, Obstetrics, and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH.

Abstract

BACKGROUND:

Single-port laparoscopy has gained popularity within minimally invasive gynecologic surgery for its feasibility, cosmetic outcomes, and safety. However, within gynecologic oncology, there are limited data regarding short-term adverse outcomes and long-term hernia risk in patients undergoing single-port laparoscopic surgery.

OBJECTIVE:

The objective of the study was to describe short-term outcomes and hernia rates in patients after single-port laparoscopy in a gynecologic oncology practice.

STUDY DESIGN:

A retrospective, single-institution study was performed for patients who underwent single-port laparoscopy from 2009 to 2015. A univariate analysis was performed with χ2 tests and Student t tests; Kaplan-Meier and Cox proportional hazards determined time to hernia development.

RESULTS:

A total of 898 patients underwent 908 surgeries with a median follow-up of 37.2 months. The mean age and body mass index were 55.7 years and 29.6 kg/m2, respectively. The majority were white (87.9%) and American Society of Anesthesiologists class II/III (95.5%). The majority of patients underwent surgery for adnexal masses (36.9%) and endometrial hyperplasia/cancer (37.3%). Most women underwent hysterectomy (62.7%) and removal of 1 or both fallopian tubes and/or ovaries (86%). Rate of adverse outcomes within 30 days, including reoperation (0.1%), intraoperative injury (1.4%), intensive care unit admission (0.4%), venous thromboembolism (0.3%), and blood transfusion, were low (0.8%). The rate of urinary tract infection was 2.8%; higher body mass index (P = .02), longer operative time (P = .02), smoking (P = .01), hysterectomy (P = .01), and cystoscopy (P = .02) increased the risk. The rate of incisional cellulitis was 3.5%. Increased estimated blood loss (P = .03) and endometrial cancer (P = .02) were independent predictors of incisional cellulitis. The rate for surgical readmissions was 3.4%; higher estimated blood loss (P = .03), longer operative time (P = .02), chemotherapy alone (P = .03), and combined chemotherapy and radiation (P < .05) increased risk. The rate of incisional hernia rate was 5.5% (n = 50) with a mean occurrence at 570.2 ± 553.3 days. Higher American Society of Anesthesiologists class (P = .04), diabetes (P < .001), hypertension (P = .043), increasing age (P = .017; hazard ratio [HR], 1.03), and body mass index (P < .001; HR, 1.08) were independent predictors for incisional hernia development. Previous abdominal surgeries (P = .24) and hand assist (P = .64) were not associated with increased risk for incisional hernia. Patients with American Society of Anesthesiologists class III/IV had a 3 year hernia rate of 12.8% (HR, 1.81). Patients with diabetes mellitus had a 3 year hernia rate of 23.0% (HR, 3.60).

CONCLUSION:

In this large cohort of patients undergoing single-port laparoscopy, the incidence of short-term adverse outcomes is low. While the rate of incisional hernia was 5.5%, incidence reached 23.0% at 3 years in high-risk groups. Previous studies with short follow-up duration may underestimate the risk of hernia, especially in patients with significant comorbidities.

KEYWORDS:

adverse outcomes; gynecologic oncology; incisional hernia; laparoendoscopic single-site surgery; minimally invasive surgery; single-incision laparoscopy; single-port laparoscopy

PMID:
28619688
DOI:
10.1016/j.ajog.2017.06.008
[Indexed for MEDLINE]

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